Domestic violence and women's health in Thailand.

The Research on Domestic Violence and Women's Health was jointly conducted by the Institute of Population and Social Research, Mahidol University, and the Foundation for Women (FFW). The research team utilized two research methodologies, namely the population-based survey and qualitative data collection by focus group discussion and in-depth interviews. The population-based survey was conducted in the Capital and the other province by selecting a probability proportional to size sample of 1,535 women in Bangkok as well as 1,281 women in the other province, totaling 2,816. The sampled women were in the age range of 15-49 years old; each selected from a sampled household. Each woman was interviewed by use of a structural questionnaire during May-August 2000. The qualitative data collection was gathered through 4 focus groups of men and women in each province. In addition, 34 individuals comprising 11 government officials, 7 women with experience of intimate partner violence, and 8 couples with intimate partner violence were also included.

The research aimed to analyze 4 issues concerning intimate partner violence in Thailand:

(1) The prevalence rate of intimate partner violence

(2) Risk factors or determinants of intimate partner violence

(3) The health impact of violence upon women suffering from violence by their male partners

(4) The coping strategies of women facing intimate partner violence

The findings about these 4 issues could help promote understandings about the state of the problems and degree of violence. They can also reveal physical and mental health associated with intimate violence that women have suffered. These finding can also be useful for improvement and development of a medical service and public health system to respond to the needs of women living with intimate violence. The research intended that the findings would be used for a public advocacy campaign pressuring for sustainable practical and policy solutions towards intimate partner violence.

What is the focus of the study?

Domestic violence against women in this study is defined as 'any act or omission by a family member (most often a current or former husband or partner), regardless of the physical location where the act takes place, which negatively affects the well being, physical or psychological integrity, freedom or right to full development of a woman'

The study focuses on physical and sexual violence by current and former intimate partners. Physical violence includes, but is not limited to: pushing, shoving, throwing, choking, slapping, punching, hitting, kicking, dragging, beating up, burning, the threat of use or the actual use of a weapon. Sexual violence includes, but is not limited to, physically forced sex, having sex because of fear, and being forced to do something sexual that is found un-natural or distasteful.

How big is the problem?

Lifetime Physical and Sexual Violence

* 23% of women in the capital and 34% in the other province reported physical violence by their intimate partner at any one time in their life.

* 30% of women in the capital and 29% in the other province reported that they had experienced sexual violence by an intimate partner.

* Combining these, close to half of the women in both study areas (41% in the capital and 47% in the other province) had experienced either physical or sexual violence by an intimate partner.

Physical Violence During Pregnancy

4% of women who had ever been pregnant in both the capital and the other province had experienced physical violence during a pregnancy. Of these about one-quarter reported that they had been punched or kicked in the abdomen during pregnancy. In most cases the perpetrator is or was the father of the child.

Sexual Violence in Childhood before the age of 15

About 8% of women in the capital and 5% in the other province reported sexual violence before the age of 15 i. In the capital, the main perpetrators are strangers (56%) while in the other province are people they knew (63%).

What are some consequences on women?

Health Impact on Women

50%of women who had experienced physical violence in the Capital and 44% in the other province had been injured as a result of physical violence by an intimate partner. About one-third of women who had serious injuries requiring hospital care never s sought medical treatment.

Physical violence had effect on women's work. Many women reported losing concentration (22% in the Capital and 14% in the other province) or having to take sick leave because of injuries (13% in the Capital and 11% in the other province).

51% of women experienced both physical and sexual violence in the Capital and 42% in the other province ever thought of ending their life, compared with 16% among women who never experienced partner violence in both sites.

About two-thirds of women reported that their children had witnessed the incidences of violence (59% in the Capital and 56% in the other province).

How do women cope with the physical violence?

Two-thirds of women have fought back when they were abused and 43% in the Capital and 36% in the other province had ever left their home as the result of physical violence.

About 37% of women in the Capital and 46% in the other province who experienced physical violence NEVER told anyone about their experiences. Among the women who DID tell someone, most of them turned to their immediate family members and friends for support. Only 10% in the other province and 20% in the Capital turned to external sources, e.g. polices, health providers, etc. for help. Main reasons for seeking help are because they could not endure any more and they were badly injured.

Research findings and their implications

Overall research findings suggest that intimate partner violence against women happened to a significant number of women. Forty-one percent of ever-partnered women in Thailand's capital city had encountered physical or sexual violence by their male partners. In the other province, the research found 47% of women with similar experience. In both provinces, more than half of these women were victimized more than one time. About one-third of women in the survey experience psychological violence perpetrated by their male partners. Beside intimate partner violence, the research findings show a high rate of sexual violence against women by non-partners. In the Capital, non-intimate partner violence registers at the 14% prevalence rate and in the other province, 7%

The research findings clearly show the physical and mental health impact of intimate partner violence. Women victims suffered physical injuries after the physical attacks by their male partners. Note must be taken that more than 50% of women with serious injuries did not seek professional medical treatments. Women who faced both sexual and physical violence undeniably suffered from poor mental health as a result of the violence. The impact on their mental health was acute if their victimization took place in the previous year. Similarly, the women who were sexually assaulted in their childhood and adulthood did not have a healthy mental state.

Women who lived with intimate violence did not have many coping strategies. Thai society expects the couples to sort out domestic violence issues on their own. Therefore, women victims opted to suffer silently. When they sought advice, the suggestions especially from non-family members were not often useful. Alone, the women had to cope with the problem. Only when the violence exacerbated and resulted in fatal injuries, the victims would seek help from police or medical personnel.

The helplessness/assistancelessness situation of victims of intimate partner violence can be exacerbated if they lived in a community that did not see the on-going violence. In such communities, the women were in absolute despair. The findings from this research reveal the majority of women living with intimate violence had no information about organizations specializing in assisting victims of intimate partner violence. Thus, the number of women seeking help from these organizations in the state and nonstate sectors were far and few in between. Such a condition reflects women's lack of access to existing services. Moreover, these organizations exist only in the Capital and a few other big cities: Shelter homes for women run by the Public Welfare Department are available in only a few big provinces. Yet, they do not provide a full range of necessary services. And not many women sought the assistance provided.

According to the findings, women with children often chose to endure violence by their partners. These women were concerned about their children and did not want to leave them behind. Should there be service providers that can accommodate the women and their children, women living with violence would have another option without having to choose between their own safety and that of their children. The extension of service coverage to the women's children is necessary. It is in line with the client-oriented approach, which both serves the women's need and respects their decision.

Additional to temporary shelters, medical personnel should be sensitive to issues associated with intimate partner violence. Medical personnel are a significant group of service providers. Women injured by their partners' attack did not always reveal the cause of their injuries to doctors and nurses attending them. Hence, the ability of medical service providers to identify intimate partner violence-related injuries is of critical importance. Quite often, medical personnel have the ability to neither treat the patient nor counsel them. It is of critical importance that doctors and nurses working in emergency units receive sensitivity training on intimate partner violence against women.

Another urgent action additional to the training concerns establishing guidelines on preliminary assistance for victims of intimate partner violence the victims shall receive necessary assistance according to their individual needs and appropriate counseling. The guidelines can be an initial step towards assuring the victims alternatives to living with violence. The findings from this research can be used as basic inputs for the design of the guidelines, especially with regards to appropriate responses by public health personnel. For example, women living with intimate violence tend to use painkillers and sleeping pills more that women who do not have violent partners. Moreover, the former are prone to commit suicide. By reaching out to victims of violence and suggesting appropriate coping strategies can help reduce their dependence on the pills and perhaps prevent suicide. Likewise, women with a history of suicide or attempted suicide may be living with violence. The doctors and nurses' sensitivity and knowledge about available services for victims of domestic violence can translate into valuable prevention and intervention measures against violence against women.

In brief, the findings from this research confirm that intimate partner violence has significant health impact and correlate with prevailing societal gender attitudes. Health care personnel do play a key role in assisting the victims and women who are at risks. The family, school, and media, too, are undeniably key institutions to stem the root cause of intimate violence. They must address the cultural root cause of violence. Effective action to eliminate violence against women will require a concerted effort from all organizations and social sectors, including civil society networks, and participation from grassroots communities.

The Capital

59%   no violence
41%   experienced violence

11%   Physical violence only       > Physical violence 23%
12%   Physical & Sexual violence   > Physical violence 23%
                                   > Sexual violence 23
18%   Sexual violence only         > Sexual violence 30 %

Other Province

53%   no violence
47%   experienced violenced

18%   Physical violence only       >  Physical violence 34%
16%   Physical & Sexual violence   >  Physical violence 34%
                                   >  Sexual violence 29%
13%   Sexual violence only         >  Sexual violence 29%

NOTE: Table made from pie graph.

This investigation received technical and financial support from the Worm Health Organization. The study used the protocol and questionnaire developed by the Core Technical Team of the WHO Multi-country Study on Women's Health and Domestic Violence. For more information please contact Dr. Kritaya Archavanitkul ([e-mail]), Dr. Churnrurtai Kanchanachitra ([e-mail]), Dr. Wassana Im-em ([e-mail]): The Institute for Population and Social Research, Mahidol University, Salaya, Nakhonpathom 73170, Thailand; or Ms. Usa Lerdsrisuntad ([e-mail]): Foundation for Women, PO Box 47 Bangkoknoi, Bangkok 10700, Thailand